GPs urged to intervene early in lung disease

The burden of respiratory disease in the population could be greatly reduced by a drive to intervene earlier in patients' lives, and even before they are born, according to experts.

Early life factors can affect later development of respiratory disease (iStock)
Early life factors can affect later development of respiratory disease (iStock)

Speakers at the 2014 European Respiratory Society (ERS) International Congress in Munich, Germany, described a growing area of research aiming to understand how early life factors affect the development of disease into adulthood.

Latest figures released at the event showed one in eight people in Europe die from lung disease, a position which has not improved since last year. This is equivalent to one death every minute.

Experts said asthma prevalence, particularly allergy and rhinitis- related cases, continues to rise across western Europe, although long-term data suggest this trend has begun to level off since 2000. The slow-down has been accompanied by a disproportionately large increase in prescriptions, they said.

But discussion of the effect of poor respiratory health during childhood and pregnancy dominated proceedings at the congress.

Dr Marielle Pijnenburg from Erasmus University in Rotterdam, the Netherlands, who addressed the congress on paediatric trends in asthma, described the preschool period as the 'key to adult life'.

Dr Erika von Mutius from the University of Munich said: 'Children migrating from lowand middle-income areas to affluent countries retain a lower prevalence of asthma, suggesting a critical time window for childhood outcomes early in life.'

A meta-analysis of 24,000 European children found that respiratory health could be affected from the moment of birth. The study, presented by Dr Liesbeth Duijts from the Erasmus Medical Center in Rotterdam and co-authored by UK researchers, found that preterm birth, low birthweight and high infant weight gain were all linked to increased incidence of childhood asthma.

UK researchers said lung function at 14-17 years old could be predicted from measurements of height, weight and FEV1 taken when patients were eight years old.

Dr Cecile Svanes from the University of Bergen, Norway, said it was also important to focus on adolescents to 'improve respiratory health of future generations'. She was the lead author of a study that found men who smoke prior to conception triple the risk of their future children developing non-allergic asthma.

Dr Svanes believes the findings will have 'profound implications' for public health policies. 'Smoking prevention is already very successful. And it's important to keep that focus, but particularly in the very young,' she said.

Elsewhere at the congress, research presented by Dr Cindy McEvoy from Oregon Health and Science University in the US found that if pregnant women who smoked took vitamin C supplements, it protected their infant from some of the harmful effects of tobacco. She said: 'Vitamin C may be an inexpensive and simple approach to decrease the effects of smoking in pregnancy on newborn pulmonary function and respiratory morbidities.'

Although welcoming the results, Dr Pijnenburg warned about relying solely on this strategy, as infants of women who did not smoke still had better lung health than those of women who smoked and took vitamin C. 'I think we should discuss if this is what we want, because obviously smoking cessation is by far the preferred option here,' she said. 'Also, there is no evidence for vitamin C having an effect on other adverse outcomes of maternal smoking.'


Conference in brief

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